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CHAIN OF CUSTODY RECORD <br /> j Advanced <br /> t Date Page i of <br /> GeoEnvironmental, Inc. <br /> 637 Shaw Road - Stockton, California- 95215- (209) 467-1006- Fax (209)467-1118 <br /> Client Project Manager <br /> Tests Required <br /> 111-1 <br /> Li <br /> Phone Number <br /> Samplers: ( g ature) Invoice: <br /> Project Name AGE <br /> I 0 n <br /> Client F] <br /> Sample Type <br /> Sample Location pate Time Water Solid No. of Notes Description comp Drab Air Conts. <br /> e tnq a y: C igna Received by. rgrsature {— Date[Time <br /> Relinquished by: (Si ature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) DatelTime <br /> Dispatched by: (Signature) Date/TimeER�M;Wr Laborator Date[Tima <br /> Method of Shipment: r �� /O�P��, / Laboratory Name { <br /> RECD SEALED&INTACT VIA ( f� <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br /> FIFAD SPACEABSEN•T CONTAINERS <br /> DE HLORINA ED IN I.AE PRESERVEI)IN LAA <br /> Vaas oYN MgtALS I arnLKIL <br /> r:o r.e�n�rn•rrnr.r <br />